TEMPORARY PACING
Restore hemodynamic stability TEMPORARILY!!
Battery operated…..electrical stimulation of heart via electrode at APEX of RV and or
Atrium
INDICATIONS FOR USE
-symptomatic bradycardia….Acute MI, SSS…SA node is old
-new bifasicular block….anterior MI
-Post CABG
-permanent pacer FAILED!
-over ride or over drive pacing
-drug or electrolyte toxicity….ex……HYPERK!!!....HEART BLOCK! HEART BLOCK!
ROUTES
-TRANSVENOUS!!!!! ALWAYS, ALWAYS IN A VEIN!!!!!!!!!!
-Epicardial…..after a CABG
-transcutaneous/external…..electricle
LEADS
-unipolar
-bipolar
-epicardial….PUT IN AFTER CABG!!!....(+) to (+)
*GET CXR AFTER PROCEDURE IF IT’S DONE @ BEDSIDE…BC RISK FOR PNEUMO!!!
PACER DOES NOT HELP THEM OUT WITH THE MECHANICAL FUNCTION!! ONLY
ELECTRICAL!!!
,MODES
FIXED RATE…..ASYNCHRONOUS…..NOT SYNCHRONIZED W/Pt
-It is set at a fixed rate…..regardless of pt. own rhythm.
-The problem is that when the pt. rhythm actually works normally…the pacer
could fire on the T waves of the normal beat…then pt can go into
V-Fib or
whatever
-So when will you see this????...when someone’s HR is way low, like 30!!
Ex….pacer fires at 70BPM no matter what!!
DEMAND RATE….synchronous…..synchronized w/ pt
-Sensitive to the pt. own rhythm
-Pacer set to fire when pt. rhythm DOES NOT FUNCTION AT PREDETERMINED
RATE
-ONLY FIRES WHEN NEEDED! Ex…Pt. HR is 70BPM….PACER KICKS IN AT <70!!!!!!
AV SEQUENTIAL
-electrode in Atrium and Ventricle
-fires in both of the chambers or just the chamber needed
-It’s important for the atria to be working a little so it can do the next
step…..
-permits adequate ventricular filling
, PACEMAKER SETTINGS
RATE: -usually 70 BPM
-10-15 beats higher than normal rate
MA: -miliamp
-voltage…or current…necessary to create an electrical impulse…..to depolarize
the Ventricle or
Atrium.
-Transvenous is usually set at 0.5-1.0 OR until you get a paced beat.
-Epicardial…bc it’s on the outside…it will need more….set at 7-10 MA
-Transcutaneous….titrate until you get a paced beat
-you want the least amt of MA to pace the heart!!!!!!
-when pacer fires….there is a “spike” followed by a “QRS” or “P” wave
-spike followed by “QRS” = 100% CAPTURE!!!
-spike followed by nothing = FAILURE TO CAPTURE
SENSITIVITY: ability to detect the pt. own rhythm
-failure to sense ……..SPIKES FALL ANYWHERE OR NOT AT ALL!!!!
Undersensing- pacer unable to sense spontaneous beats from pt….
-results in competition btw paced beats vs. pt. norm. beats
-SPIKES FALL ANYWHERE!!!!
*****DANGER…..PACING BEATS FALL ON “T” WAVE!!!!
Restore hemodynamic stability TEMPORARILY!!
Battery operated…..electrical stimulation of heart via electrode at APEX of RV and or
Atrium
INDICATIONS FOR USE
-symptomatic bradycardia….Acute MI, SSS…SA node is old
-new bifasicular block….anterior MI
-Post CABG
-permanent pacer FAILED!
-over ride or over drive pacing
-drug or electrolyte toxicity….ex……HYPERK!!!....HEART BLOCK! HEART BLOCK!
ROUTES
-TRANSVENOUS!!!!! ALWAYS, ALWAYS IN A VEIN!!!!!!!!!!
-Epicardial…..after a CABG
-transcutaneous/external…..electricle
LEADS
-unipolar
-bipolar
-epicardial….PUT IN AFTER CABG!!!....(+) to (+)
*GET CXR AFTER PROCEDURE IF IT’S DONE @ BEDSIDE…BC RISK FOR PNEUMO!!!
PACER DOES NOT HELP THEM OUT WITH THE MECHANICAL FUNCTION!! ONLY
ELECTRICAL!!!
,MODES
FIXED RATE…..ASYNCHRONOUS…..NOT SYNCHRONIZED W/Pt
-It is set at a fixed rate…..regardless of pt. own rhythm.
-The problem is that when the pt. rhythm actually works normally…the pacer
could fire on the T waves of the normal beat…then pt can go into
V-Fib or
whatever
-So when will you see this????...when someone’s HR is way low, like 30!!
Ex….pacer fires at 70BPM no matter what!!
DEMAND RATE….synchronous…..synchronized w/ pt
-Sensitive to the pt. own rhythm
-Pacer set to fire when pt. rhythm DOES NOT FUNCTION AT PREDETERMINED
RATE
-ONLY FIRES WHEN NEEDED! Ex…Pt. HR is 70BPM….PACER KICKS IN AT <70!!!!!!
AV SEQUENTIAL
-electrode in Atrium and Ventricle
-fires in both of the chambers or just the chamber needed
-It’s important for the atria to be working a little so it can do the next
step…..
-permits adequate ventricular filling
, PACEMAKER SETTINGS
RATE: -usually 70 BPM
-10-15 beats higher than normal rate
MA: -miliamp
-voltage…or current…necessary to create an electrical impulse…..to depolarize
the Ventricle or
Atrium.
-Transvenous is usually set at 0.5-1.0 OR until you get a paced beat.
-Epicardial…bc it’s on the outside…it will need more….set at 7-10 MA
-Transcutaneous….titrate until you get a paced beat
-you want the least amt of MA to pace the heart!!!!!!
-when pacer fires….there is a “spike” followed by a “QRS” or “P” wave
-spike followed by “QRS” = 100% CAPTURE!!!
-spike followed by nothing = FAILURE TO CAPTURE
SENSITIVITY: ability to detect the pt. own rhythm
-failure to sense ……..SPIKES FALL ANYWHERE OR NOT AT ALL!!!!
Undersensing- pacer unable to sense spontaneous beats from pt….
-results in competition btw paced beats vs. pt. norm. beats
-SPIKES FALL ANYWHERE!!!!
*****DANGER…..PACING BEATS FALL ON “T” WAVE!!!!
